Transcript Provider Tips and Toolsets Rural Quality Program

Provider Tips and Toolsets
Rural Quality Program Conference
Office of Rural Health Policy
Health Resources Services Administration
September 2, 2009
Kathy Reims, MD
Chief Medical Officer
CSI Solutions, LLC
Clinical Assistant
Professor, UCHSC
I do not have any relevant
financial relationships to
disclose
Eugene Maynard, MD
Rural Quality Project
Participant Benson Area
Medical Center
Benson, NC
Objectives

Provide practical tools and tips to
improve performance on OHRP CVD
measures
◦ General approach
◦ Hypertension and Lipid control
◦ Integrated Smoking Cessation Toolkit
Tools to Improve Performance
Patient Factors
 Care Team Factors
 System Factors

Patient Factors
Awareness*
 Education*
 Commitment to Care Plan
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Patient confidence in managing condition*
Side effects
Practical considerations
Psychosocial impacts*
Assist Patients with Care Plans
Self-Management supports*
 Proactive follow up*
 Care Team is accessible
 DAP programs
 Pay attention to medication regimens
 Medication reconciliation
 Screen for literacy*, depression*,
substance abuse

Care Team Factors

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Evidence-based care*
Planned Care
◦ POS prompts and reminders*

Protocols
◦ Trained Staff*
◦ Delegated work*

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Outreach and proactive follow up*
Expand the team: pharmacist, promotora
Optimize the team: designated roles or FTE*
System Factors

Access
◦ Group visits*
◦ Email or Web-based
◦ Convenient, timely appointments
Continuity of care
 Population management*
 Coordination of care
 Effective use of technology*

Awareness: BP Control Rates
Trends in awareness, treatment, and control of high
blood pressure in adults ages 18–74
National Health and Nutrition Examination Survey, Percent
II
1976–80
II
(Phase 1)
1988–91
II
(Phase 2)
1991–94
1999–2000
Awareness
51
73
68
70
Treatment
31
55
54
59
Control
10
29
27
34
Sources: Unpublished data for 1999–2000 computed by M. Wolz, National Heart, Lung, and Blood Institute; JNC 6.
Awareness: Guidelines
Patient Education
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/dash_brief.pdf
Education and Patient Reminders:
BP Wallet Card
BP Wallet Card
Education and Patient Reminders:
National Cholesterol Education Program
http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.pdf
HTN & Lipid Patient Education
http://www.nhlbi.nih.gov/health/index.htm
 http://www.americanheart.org/presenter.j
html?identifier=1516
 http://familydoctor.org/online/famdocen/h
ome/common/heartdisease/risk/092.html
 http://www.webmd.com/heartdisease/guide/heart-disease-prevent
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Patient Self Management
http://www.amaassn.org/ama1/pub/upload/mm/
433/phys_resource_guide.pdf
BUBBLE DIAGRAM
If you have diabetes, here are some things many individuals try to do for their
health. Would you like to set any goals concerning any of them?
Blood glucose
monitoring
Skin care
Taking medications
to help control
blood sugar
Taking insulin
Diet
Depression

Losing weight
Daily foot care
Smoking
Goal Setting Tools
www.healthdisparities.net
Plan the Visit: Flowsheet
•Organize key
information
•POS Reminders
•Share the work
•Huddles
Plan the Visit: Electronic Flow Sheet
Delegated Work: Standing Orders
Standing Orders
Evidence-based care:
JNC VII Reference Card
JNC VII Reference Card, side 2
Evidenced-based Care
ATP III Palm Interactive Guideline Tool
http://hp2010.nhlbihin.net/atpiii/atp3palm.
htm
 CVD Risk Calculator
http://hp2010.nhlbihin.net/atpiii/calculator.
asp
 ATP III At-a-Glance Desk Reference
http://www.nhlbi.nih.gov/guidelines/choles
terol/dskref.htm

Staff Training:
Lunch and Learns
JNC VII Slide Set
http://hp2010.nhlbihin.net/nhbpep_slds/m
enu.htm
 AAFP Ask and Act Program
http://www.aafp.org/online/en/home/clinic
al/publichealth/tobacco/toolkit.html
 ATP III Slide Set
http://hp2010.nhlbihin.net/ncep_slds/men
u.htm

Staff Training:
Unified Health Communication 101:
Addressing Health Literacy, Cultural
Competency, and Limited English
Proficiency
Improve your patient communication
skills
 Increase your awareness and knowledge
of the three main factors that affect your
communication with patients
 Implement patient-centered
communication practices

Optimize your Team:
Case Manager Role
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Plans and integrates care for people with diabetes and other
chronic diseases
Liaison with other community resources
Provide good documentation in patient record, all patient
contact attempts, and all telephone and written
communication with patients
Log in binder the appointment date/time/location; check off if
the letter was sent, phone call made, films requested
Reviews charts for what is needed (with help of other team
members)
Coordinate with other team members
Help with referrals and links to community resources as
needed
Helps counsel around self-management goals
Optimize your Team: Outreach Log
Manage your Population: use your
data
Health Literacy Screen
Newest Vital Sign
http://www.pfizerhealthliteracy.com
/pdf/FH_vitalsigns_040605.pdf
Depression Screening

http://www.commonwealthfund.org/usr_doc/PHQ2.pdf
PHQ -9
http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/
Why Process Map?
Creates a visual snapshot of the current
flow of the process
 Allows you to “see” opportunities for
improvement
 Facilitates identification of process
variations, duplications and waste
 Adds a discipline to improvement
 Allows involvement of all key players

Patient given
order for
fasting lipids
Lipids at
target?
Yes
Results
notification
mailed
No
RN enters
patient
name and
date into log
(in lab)
Returned
results are
processed by lab
staff and results
entered into log
Lab gives
results to PCP
PCP orders
follow up visit
RN schedules
appointment
But what
about….?
Patient given
order for
fasting lipids
RN enters
patient name
and date into
log (in lab)
Lipids at
target?
No
Lab gives results to
PCP. PCP orders
follow up visit.
Log checked q
2 weeks for
follow up
phone calls
needed
RN schedules
appointment and
places reminder
in tickler file
Returned results
are processed by
lab staff and
results entered
into log
Front desk checks
tickler and reports
no-show
appointment to RN
Yes
Results
notification
mailed
Gaps addressed:
1. Follow up for Lipid
results that have not
been returned
2. Ability to track if
patient received
timely follow up on
elevated lipids.
Smoking Cessation Toolkit
An Integrated Approach